The mental health of children and adolescents (aged 0–18 years) is one of the most neglected health issues globally. Before COVID-19, the WHO estimated that 10–20 per cent of children and adolescents worldwide experienced poor mental health, with half of mental disorders beginning by age 14.1 In East Asia and the Pacific, almost 1 in 7 boys and 1 in 9 girls aged 10–19 years have a mental disorder, with suicide estimated to be the thirdii leading cause of death of 15–19-year-olds in this region.2,3 Additionally, millions more children and adolescents experience psychological distress that may not meet diagnostic criteria for mental disorder but which has significant impacts on their health, development and well-being.

 

Poor mental health can have profound impacts on the health, learning, social well-being and participation of children and adolescents, limiting opportunities for them to reach their full potential. This age spectrum encompasses a time of critical brain growth and development, when social, emotional and cognitive skills are formed, laying the foundation for mental health and well-being into adulthood. In addition to mental disorders arising during this age, many risk factors for future poor mental health also typically have their onset in this developmental stage.

 

Despite this burden, there is a substantial unmet need for MHPSS for children and adolescents. Globally, government expenditure on mental health accounts for only 2 per cent of total health expenditure, despite accounting for 7 per cent of the total burden of disease. In low- and middleincome countries, the estimated ratio of mental health specialists with expertise in treating children and adolescent is <0.5 per 100,000 population, and there are fewer than two outpatient facilities for child and adolescent mental health per 100,000 population. There are also many gaps and missed opportunities to prevent poor mental health and promote well-being, with approaches often fragmented and small-scale. In addition to inadequate human and financial resources, a lack of coordination between sectors and substantial stigma remain significant barriers to ensuring children, adolescents and their families have access to quality services and support. COVID-19 both exacerbated mental health issues impacting children and young people across the region and highlighted the significant gaps in systems and services.

 

To address the mental health and psychosocial well-being of children and adolescents there is an urgent need to transform the current approach to:

 

Shift the emphasis from medicalization of mental illness to the value of ensuring mental health and well-being to society and communities;

 

Address the overemphasis on scaling up specialist clinical services for mental disorder and move to providing an optimal mix of services and supports to promote mental health across sectors;

 

Expand the scope of mental health to include a focus on creating an enabling environment that enhances protective factors and reduces risk factors across the life cycle, recognizing the gendered nature of mental health and the importance of resilience, empowerment and social cohesion for psychosocial well-being; and

 

Ensure that the perceptions, experiences and views of children and adolescents are central not only to understanding their mental health needs but also to shaping and strengthening mental health services and systems

 

This research initiative seeks to provide guidance for this transformation, with a focus on the provision of a holistic and tiered approach to MHPSS that includes actions to: promote well-being; prevent poor mental health by addressing risks and enhancing protective factors; and ensure quality and accessible care for those with mental health conditions. This requires the mobilization of all sectors – including health, education, social welfare and justice – as well as engagement with communities, schools, parents, service providers and children and adolescents themselves. This multisectoral approach is therefore at the core of UNICEF’s East Asia and Pacific regional framework on MHPSS, and UNICEF’s Global Multisectoral Operational Framework for mental health and psychosocial support of children, adolescents and caregivers across settings.

 

Source: UN Children’s Fund